Manager of Provider Contracts at The Pill Club
San Carlos, CA, US
About The Pill Club
We are a family of medical professionals, women's health advocates, and software engineers on a mission to simplify the process of getting birth control! If you are interested in working at a rapidly growing healthcare startup and want to get in on the ground floor of building a company that’s changing the way birth control is dispensed please consider joining our team!

Responsibilities:

    • - Assist with developing, contracting, implementing, and maintaining new and existing provider networks.
    • Monitor contractual relationships with existing contracted providers.
    • Assist with State and Federal Regulatory reporting of contracts and provider network. - Point person with provider network for contract issues as required by Head of Market Access
    • Assist with developing draft contracts, coordinate reimbursement rate terms with Finance department, work with Compliance department to ensure contract language meets regulatory requirements
    • Effectively communicate TPC's mission during contracting efforts
    • Participate in routine meetings with staff to foster collaboration and excellent working relationships
    • Obtain signatures on original contracts, contract renewals, and amendments as needed
    • Prepare contract and provider network information necessary to support filings with regulatory agencies such as the California Department of Health Care Services (DHCS), Department of Managed Health Care (DMHC), and Centers for Medicare Medicaid Services (CMS)
    • Assist with documentation preparation required for internal and external audits
    • Assist with resolving provider complaints and problems related to contractual issues
    • Maintain and monitor new contracts notification process and follow up with internal departments to ensure systems are updated timely
    • Communicate activities and/or issues identified during contracting process with Head of Market Access

Requirements:

    • Bachelor's degree in Healthcare, or related field
    • minimum 5 years of experience working with a managed care organization or health insurer, in a network/contract management role, such as contracting, provider services, etc
    • Experience with complex physician/facility/ancillary contract reimbursement methodologies
We are an Equal Employment/Affirmative Action employer. We do not discriminate in hiring on the basis of sex, gender identity, sexual orientation, race, color, religious creed, national origin, physical or mental disability, protected Veteran status, or any other characteristic protected by federal, state, or local law.